EP1056400B1 - Coaxial needle and severing snare - Google Patents
Coaxial needle and severing snare Download PDFInfo
- Publication number
- EP1056400B1 EP1056400B1 EP99903249A EP99903249A EP1056400B1 EP 1056400 B1 EP1056400 B1 EP 1056400B1 EP 99903249 A EP99903249 A EP 99903249A EP 99903249 A EP99903249 A EP 99903249A EP 1056400 B1 EP1056400 B1 EP 1056400B1
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- European Patent Office
- Prior art keywords
- snare
- needle
- sheath
- endoscope
- lumen
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/32056—Surgical snare instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3478—Endoscopic needles, e.g. for infusion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1477—Needle-like probes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00349—Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00353—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1407—Loop
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
Definitions
- the present invention relates generally to the field of tissue ligation, and more particularly to an improved device for severing lesions.
- a wide variety of lesions including internal hemorrhoids, polyps, and mucositis, may be treated by severing snare ligation.
- a targeted lesion is removed from the surrounding tissue by an electrosurgical severing snare using radio frequency (R/F) electric current to sever tissue or to achieve hemostasis.
- R/F radio frequency
- a high radio frequency is used (i.e., above 100,000 Hz.) to avoid the potentially injurious stimulation of muscles and nerves which results from lower frequency R/F energy.
- electrosurgery is typically performed at frequencies of approximately 500,000 Hz., although frequencies as high as 4,000,000 Hz. may be used.
- Radio frequency current is passed through the patient's body.
- the major difference between these two techniques is the density of the radio frequency electric current; the current density used in medical diathermy is kept low to reduce tissue heating and to prevent necrosis.
- electrosurgery There are three surgical effects that can be achieved with electrosurgery. These include electrosurgical desiccation, which is a low power coagulation caused without sparking to the tissue; electrosurgical cutting, where electricity sparks to the targeted tissue and produces a cutting effect; and electrosurgical fulguration, where electricity sparks to the targeted tissue without causing significant cutting.
- electrosurgical desiccation which is a low power coagulation caused without sparking to the tissue
- electrosurgical cutting where electricity sparks to the targeted tissue and produces a cutting effect
- electrosurgical fulguration where electricity sparks to the targeted tissue without causing significant cutting.
- bipolar outputs are preferable because the patient return electrode (necessary in monopolar procedures and a common source of accidents) is eliminated, and any desiccation performed is extremely localized because, in a true bipolar operation, only the tissue that is grasped between the two electrodes is desiccated.
- Bipolar output is less effective for cutting and fulgurating, and thus monopolar tools remain commonplace. Severing snares, for example, are almost all monopolar instruments.
- ⁇ waveforms are typically used in electrosurgery. These include a “cutting” waveform, which cuts tissue very cleanly but may cause the incised tissue to bleed excessively; a “coagulating” waveform, which desiccates and fulgurates tissue without significant cutting; and a “blended” waveform, which is a cutting waveform that has a moderate hemostatic effect.
- a waveform's “Crest Factor” describes the degree of hemostasis that a waveform will produce if properly applied.
- the wire snare is looped around the targeted lesion and is tightened as the snare is drawn into the sheath.
- the lesion is then desiccated and cut through electrosurgically. It is also possible to sever a lesion in a single step by cutting with a "blended" current. This allows a snare to cut through a lesion in one pass without having to worry about bleeding.
- the lesion may be cut through mechanically with a thin snare wire after the blood supply to the targeted tissue has been coagulated and the tissue has been softened by a desiccation current.
- Saline-Assisted Polypectomy has become an increasingly popular way of performing endoscopic mucosal resection (EMR) to diagnose and treat diseases of the gastrointestinal tract.
- EMR endoscopic mucosal resection
- a surgeon passes a needle through an endoscope and inserts the needle into the submucosa layer proximate to the lesion.
- the surgeon injects physiological saline into the submucosa to elevate the lesion on a bed of saline solution. Once elevated, the surgeon can easily remove the lesion by passing an electrosurgical severing snare over the lesion and ligating the lesion.
- SAP typically requires the use of a large diameter double-channel endoscope, which is difficult to introduce into the patient and is hard to manipulate.
- grasping forceps must be used to lift the lesion off of the layer of saline solution, which may result in a tear in the mucosa.
- EAM endoscopic aspiration mucosectomy
- Torii et al. in “Endoscopic Aspiration Mucosectomy as Curative Endoscopic Surgery," Gastrointestinal Endoscopy, Vol. 42, No. 5 (1995), EAM can be used to lift up a targeted lesion with suction, rather than with forceps, thereby reducing the risk of injury to the mucosal surface.
- a double-channel endoscope is introduced into the patient, the lesion is marked with a needle knife, and saline solution or Glyceol TM (e.g., a hypertonic solution of 10% glycerol, 5% fructose, and physiological saline solution; available from Chugai Pharmaceutical Co., Tokyo, Japan) is injected into the submucosal layer beneath the lesion to separate the lesion from the layer.
- saline solution or Glyceol TM e.g., a hypertonic solution of 10% glycerol, 5% fructose, and physiological saline solution; available from Chugai Pharmaceutical Co., Tokyo, Japan
- the double-channel endoscope is withdrawn from the patient and a single-channel, video endoscope equipped with a transparent aspiration cylinder is introduced into the patient and (e.g., a Teflon ® tube through which suction is applied) an electrosurgical severing snare is tightened around the outer circumference of the cylinder.
- a transparent aspiration cylinder e.g., a Teflon ® tube through which suction is applied
- an electrosurgical severing snare is tightened around the outer circumference of the cylinder.
- the lesion and the surrounding mucosa are aspirated into the cylinder and the snare is pushed off the cylinder and tightened around the lesion to ligate the lesion.
- the lesion may be severed further down on the stalk than possible with SAP.
- the severed tissue may remain aspirated into the cylinder to retrieve the sample for further study. Alternately, the severed tissue may be aspirated out of the cylinder to pass through the body naturally.
- EAM procedure described by Torii et al. may offer certain advantages over SAP, it still has its disadvantages.
- a surgeon must switch between a double-channel endoscope having a needle knife and an injection needle (for marking the lesion and injecting-solution), and a more maneuverable single-channel endoscope having a severing snare and an aspiration cylinder(for ligating and aspirating the lesion) because the working channel of a single-channel endoscope cannot accommodate both an injection needle and a severing snare simultaneously.
- double-channel endoscopes are too large and are not desirable for the EAM procedure. Exchanging endoscopes, however, is time consuming - wasting surgeons' time and prolonging the procedure.
- multi-lumen sheath including two lumens for carrying the injection needle and severing snare.
- multi-lumen sheaths take up valuable space and make the overall endoscopic apparatus large and bulky.
- the use of two lumens within a sheath also limits the size of the severing snare and injection needle that can be used, as the instruments are disposed through the sheath side-by-side.
- the depth at which a surgeon using the apparatus disclosed by Weaver et al. may sever a lesion is limited because the device is designed to be used when performing SAP and does not, therefore, provide for an aspirating device. This prevents the use of the device of Weaver et al. in performing EAM.
- the present invention is directed to a device for treating a lesion within a living body, comprising a sheath extending from a proximal end which, in an operative position, is located outside the body, to a distal end which, in the operative position is located within the body.
- a needle extending through the sheath defines a tissue piercing distal tip and a central lumen extends through the needle from a proximal port to a distal opening formed in the distal tip.
- a needle actuator is provided for moving the needle between a retracted position in which the distal tip is received within the sheath to an injection position in which the distal tip extends distally beyond a distal end of the sheath and a snare extends within the lumen to a loop formed in a distal end of the snare.
- a snare actuator is provided for moving the snare between a covered position in which the loop is received within the lumen and an extended position in which the loop extends distally from the lumen beyond the distal tip.
- an apparatus comprises a sheath 1, having a proximal end 5 and a distal end 10.
- a lumen 15 extends between the proximal and distal ends 5 and 10, and may preferably have a substantially circular cross-section.
- a distal aperture 20 is defined at the point where the lumen 15 exits the distal end 10 of the sheath 1.
- the sheath 1 is designed to pass through the working channel 30 of an endoscope 25.
- the working channel 30 extends within the endoscope 25 from an accessible end (not shown) to a working end 35 of the endoscope 25.
- the working channel 30 is sized to allow the free passage of instruments therethrough from an opening formed in the accessible end into the working channel 30 to the working end 35.
- different scopes have working channels 30 of various diameters and that it is necessary only to size the sheath 1 so that a sufficient clearance is preserved within the channel so that the sheath 1 may freely pass through the working channel 30.
- the size of the working channel 30 is not a factor in determining the size of the sheath 1.
- aspiration cylinder 40 cylinder 40 is coupled to the working end 35 of the endoscope 25.
- the aspiration cylinder 40 which may preferably be constructed of a transparent bio-compatible plastic such as, for example, polycarbonate or lexan, includes a distal end 45, which defines a distal aperture 50 and an aspirating chamber 55.
- the aspirating chamber 55 is in communication with the working channel 30 of the endoscope 25 so that an instrument, such as that according to the first embodiment of the present invention, may be passed through the working channel 30, through the aspirating chamber 55, and through the distal aperture 50 of the aspiration cylinder 40.
- Endoscope 25 is preferably a single-channel endoscope. Alternately, the surgeon may use a multiple-channel endoscope and use one or more of the other working channels for advancing an instrument, such as a forceps 200 (shown in Fig. 7), basket, needle, or other device, through the endoscope 25, or for accommodating a fiber optical system (not shown).
- the length of the endoscope 25 should be sufficient to allow the surgeon to use the endoscope 25 and the attached aspiration cylinder 40 to reach the targeted lesions within the patient's body.
- An injection needle 60 is disposed through the lumen 15 of the sheath 1.
- the injection needle 60 defines a lumen 70, which terminates in a distal aperture 67, and has a proximal end (not shown) and a distal tip 65.
- the cross-sections of the injection needle 60 and the lumen 70 are preferably generally circular, and the cross-sectional diameter of the injection needle 60 is less than the diameter of the lumen 15 of the sheath 1, through which the injection needle 60 passes. As the cross-sectional diameter of the injection needle 60 is less than the diameter of the lumen 15 of the sheath 1, the injection needle 60 is free to move longitudinally through the lumen 15.
- the proximal end of the injection needle 60 is connected to an injection needle handle 75, which slidably engages a handle body 100.
- the injection needle handle 75 which includes an injection port 77, may be moved longitudinally along the handle body 100 from a fully-deployed position (shown in Fig. 4), wherein the injection needle handle 75 is positioned proximate to the distal end 105 (formed as a thumb handle) of the handle body 100, to a fully-retracted position (shown in Fig. 6), wherein the injection needle handle 75 has been moved away from the distal end 105 of the handle body 100 relative to the fully-deployed position.
- the needle handle 75 may also be moved further proximally to further retract the needle 75.
- the injection needle handle 75 may be positioned in any number of positions between the fully-deployed and fully-retracted positions.
- Movement of the injection needle handle 75 controls and limits the movement of the injection needle 60 through the lumen 15 of the sheath 1.
- the distal tip 65 of the injection needle 60 extends through and beyond the distal aperture 20 of the sheath 1 (as seen in Figs. 2 and 3).
- the distal tip 65 of the injection needle 60 will extend beyond the distal aperture 50 of the aspiration cylinder 40 when the injection needle handle 75 is in the fully-deployed position and the sheath 1 is properly positioned, either within the endoscope 25 (as seen in Fig. 5) or outside the endoscope 25 (as seen in Fig.
- the injection needle handle 75 When the injection needle handle 75 is in a mid-range (as seen in Fig. 3) or a fully-retracted position (as seen in Fig. 6), the distal tip 65 of the injection needle 60 is completely withdrawn within the lumen 15 of the sheath 1. By completely retracting the injection needle 60 within the sheath 1 when the injection needle 60 is not in use, a surgeon can substantially reduce the risk of accidental perforation or entanglement.
- An electrosurgical severing snare 80 is disposed within the lumen 70 of the injection needle 60.
- the severing snare 80 has a proximal end (not shown) and a distal loop 85, which is flexible and made of light-gauge wire such as nitinol or stainless steel.
- the severing snare 80 is preferably not surrounded by any insulating material so that, when r/f energy is supplied to the severing snare 80, the injection needle 60 is also "hot.”
- the sheath 1 is preferably formed as an insulator to guard against short circuiting with an interior surface of the working channel 30 and to protect tissue surrounding the lesion from damage prior to locating a final position and deploying a desired one of the needle 60 and the snare 80.
- the needle 60 may be used to cauterize bleeding vessels, or may serve as a point electrical surgery knife.
- the diameter of the severing snare 80 is less than the diameter of the lumen 70 of the injection needle 60, through which the severing snare 80 passes.
- a light-gauge wire which is less than half the diameter of the lumen 70.
- the proximal end of the severing snare 80 is connected to a snare handle 90, which slidably engages the handle body 100, and is in electrical communication with an R/F snare plug 95.
- Snare handle 90 may be moved longitudinally along the handle body 100 between a fully-deployed position, (shown in Figs. 2 and 3) in which the distal loop 85 extends from the distal end of the lumen 70, wherein the snare handle 90 is close to the distal end 105 of the handle body 100, and a fully-retracted position (shown in Fig.
- the snare handle 90 may be positioned in any number of positions between the fully-deployed and fully-retracted positions.
- Movement of the snare handle 90 controls and limits the movement of the severing snare 80 through the lumen 70 of the injection needle 60.
- the distal loop 85 of the severing snare 80 extends through and beyond the distal aperture 67 of the injection needle 60.
- the distal loop 85 of the severing snare 80 will extend beyond the distal aperture 50 of the aspiration cylinder 40 when the snare handle 90 is in the fully-deployed position, and the injection needle 60 and sheath 1 are properly positioned, either within the endoscope 25 (as seen in Fig. 6) or outside the endoscope 25 (as seen in Fig. 6), for carrying out the desired procedure.
- the distal loop 85 of the severing snare 80 is completely withdrawn and collapsed within the lumen 70 of the injection needle 60.
- the loop 85 will initially be compressed when it is drawn into the sheath 1 and, by drawing the needle 60 proximally along with the snare loop 85, a user can ensure that the snare loop 85 is collapsed by the sheath 1 before being retracted into the lumen 70.
- a surgeon can substantially reduce the risk of accidentally having another instrument, such as a forceps 200 (shown in Fig. 7) become entangled in the distal loop 85.
- the distal loop 85 of the severing snare 80 is also protected from being accidentally perforated by the injection needle 60 by the fact that the distal loop 85 is located distal to the injection needle 60.
- the distal loop 85 when fully-extended and not deformed by another object, the distal loop 85 defines a generally elliptical area, which can be referred to as having a length 1 and a width w.
- width w is reduced to approximately the diameter of the lumen 70. Accordingly, the area defined by the distal loop 85 is substantially smaller after the distal loop 85 has been collapsed than before it has been collapsed. Distal loop 85 is able to be collapsed upon being retracted because the wire that comprises the distal loop 85 is flexible.
- the distal loop 85 is preferably biased so that, when the distal loop 85 is redeployed it will return to its precollapsed state and define roughly the same area as it did before it was collapsed within the lumen 70.
- the snare loop 85 may be biased so that, when outside the lumen 70, the loop 85 extends in a plane disposed at an angle, e.g., 90°, relative to the longitudinal axis of the needle 60. That is, the loop 85 may be biased so that, when deployed, it extends across an opening of the aspiration cylinder 40. This facilitates placement of the loop 85 over a lesion aspirated into the aspiration cylinder 40.
- the R/F snare plug 95 is provided to transmit energy from an external source (not shown) to the distal loop 85 of the severing snare 80.
- the sheath 1 is designed to pass through the working channel 30 of the endoscope 25.
- the overall cross-sectional area of the endoscope is not increased due to the presence of the sheath 1, injection needle 60, and severing snare 85, although the aspiration cylinder 40 may slightly increase the profile of the endoscope 25.
- the severing snare 80 is coaxial with the injection needle 60, the combination of the two instruments takes up approximately the same amount of room within the working channel 30 that a standard injection needle would.
- the combination of the two instruments would require more room within the working channel 30, thereby necessitating the use by the surgeon of a large endoscope or the elimination of the advantages of having both instruments simultaneously present at the site of the lesion and, instead, having to perform several "exchanges" as discussed in the prior art.
- a surgeon using the present device may use an endoscope with a relatively small working channel 30 while still enjoying the benefits of locating both an injection needle 60 and a severing snare 80 simultaneously at the site of a lesion.
- the surgeon may use any "free space" within an larger diameter endoscope (such as the diameter that would be needed if the two instruments were positioned side-by-side) for passing other instruments, such as a forceps 200, through the working channel 30.
- the surgeon could select an injection needle 60 and a severing snare 80 having slightly larger diameters, thereby allowing for more injection flow through the injection needle 60 and for a stronger severing snare 80.
- the sheath 1 may be located external to the working channel 30 of a relatively small diameter endoscope 25.
- a portion of the sheath 1 is attached to the aspiration cylinder 40 by tape, cable ties, or mesh means (not shown). While this configuration enlarges the overall profile of the endoscope 25 and aspiration cylinder 40 assembly, the surgeon is then free to use another instrument, such as a forceps 200, basket, needle, or cautery device, through the working channel 30 of the endoscope 25, without having to first remove the injection needle 60 and the severing snare 80 from the patient.
- the open working channel 30 of the endoscope 25 also allows for multiple combinations of instruments to be used within the working channel 30 without having to remove the endoscope 25 from the body of the patient.
- a surgeon administers a local pharyngeal anesthesia or general anesthesia to the patient and introduces into the patient an endoscope 25 having an aspiration cylinder 40 coupled thereto.
- the surgeon then passes the sheath 1 through the working channel 30 of the endoscope 25 with the sheath 1 protecting the endoscope from being scraped or damaged by the needle as it is passed through the working channel 30.
- a needle 60 is passed through the lumen 15 of the sheath 1 with a severing snare 80 disposed within the lumen 70 of the needle 60.
- the surgeon may forgo use of a aspiration cylinder 40 and may attach the sheath 1 to the outside of the endoscope 25.
- the surgeon positions the distal end of the aspiration cylinder 40 adjacent to the lesion 205 that the surgeon wishes to remove.
- the lesion 205 as shown in Figs. 8-13 is illustrative of a lesion found in the gastrointestinal tract and may, for example, be associated with early gastric cancer or adenoma.
- the lesion 205 is part of the mucosa 210, and is positioned over a submucosa layer 215 (the muscularis basement).
- the surgeon passes an injection needle 60 (shown in Fig. 9) through the mucosa 210, and injects a sclerotherapy agent L or saline solution between the mucosa 210 and the muscularis basement 215, thereby separating the mucosa 210 from the muscularis propria 215.
- a sclerotherapy agent L such as Glyceol TM
- Glyceol TM be used rather than saline solution because the bulge formed between the mucosa 210 and muscularis basement 215 lasts longer when a sclerotherapy agent is used.
- the surgeon deploys the snare 80 and positions the loop 85 around the lesion 205 and then aspirates the lesion 205 through the loop 85 into the aspirating chamber 55 of the aspiration cylinder 40 (shown in Fig. 10) and tightens the loop 85 around the tissue to sever the lesion 205 (shown in Fig. 12).
- the surgeon is using an electrosurgical severing snare, as described in the background of the invention, he would apply the appropriate R/F energy (i.e. , "cutting,” “coagulating,” or “blended") to the snare through an R/F snare plug 95 while severing the lesion 205.
- R/F energy i.e. , "cutting,” “coagulating,” or “blended”
- the lesion 205 may be retained in the aspiration cylinder 40 to be removed from the body for further pathology study or aspirated out of the aspirating chamber 55 to pass through the body. If the lesion 205 is aspirated out of the aspiration cylinder 40, the surgeon may immediately proceed to treat a subsequent lesion (not shown) without having to remove the endoscope 25 and the aspiration cylinder 40 from the body.
- the surgeon may pass an instrument, such as a forceps 200, through the working channel 30 or an external or an addition lumen (not shown) of the endoscope 25 to grasp and retrieve the lesion 205.
- an instrument such as a forceps 200
- the sheath 1 occupies the working channel 30 and no other lumen is provided, then the surgeon could exchange sheath 1 for the desired instrument 200, or attempt to pass the instrument 200 around the sheath 1 within the working channel 30. This exchange would be eliminated, however, if the sheath 1 were connected to the outside of the aspiration cylinder 40 (as seen in Fig. 7), thereby freeing up the working channel 30 of the endoscope 25 for other instruments, such as the forceps 200.
- the forceps 200 rather than suction, would be used to separate the lesion 205 and the mucosa 210 from the muscularis propria 215. Accordingly, it would be desirable to adapt the present invention to allow for both the coaxial needle 60 / severing snare 80 instrument and the forceps 200 to be simultaneously located at the site of the lesion 205.
- the sheath 1 could be located external to the endoscope 25, thereby still allowing the surgeon to use a single-channel (rather than a double-channel) endoscope 25 to perform the SAP procedure.
- the injection needle handle 75 is preferably coupled to the severing snare handle 90 so that, when the severing snare 80 is retracted, the injection needle 60 is also retracted at least until the distal tip 65 of the injection needle-60 is received within the sheath 1.
- the diameter of the distal loop 85 will be expanded to surround the tissue and, when the snare 80 is retracted while the injection needle 60 is fully or partially deployed, the expanded loop 85 will be too large to enter the injection needle 60.
- the needle 60 will be pushed proximally by the proximal travel of the distal loop 85 until the severing loop 85 comes into contact with the distal end 10 of the sheath 1.
- Fig. 14 shows the apparatus of Fig. 14 in which no stop 110 is provided to limit the proximal travel of the needle 60, wherein both the snare 80 and the needle 60 are completely withdrawn into the sheath 1.
- Fig. 16 shows a further embodiment of the apparatus according to the present invention in which a mechanism is provided to control the motion of the needle 60 and the snare 80.
- the apparatus of Fig. 16 includes a stop 110 formed as a rod extending across the interior lumen of the handle body 100 preferably substantially perpendicular to a longitudinal axis of the handle body 100.
- the stop 110 contacts the snare handle 90 to define the distal-most position of the snare handle 90 and, consequently, the distal-most position of the snare 80.
- the stop 110 contacts the needle handle 75 to define the proximal-most position of the needle handle 75 and, consequently, of the needle 60.
- the rod 110 may be formed as a separate piece bonded to, or molded into, the interior of the handle body 100.
- an increased diameter portion 112 of the needle 60 is provided to further define the proximal and distal limits of travel of the needle 60.
- the proximal end 114 of the increased diameter portion 112 which is formed as a seal to seal the interior lumen 70 of the needle 60, facilitates contact between the stop 110 and the needle 60 and includes a receiving cavity 113 to ensure that the needle 60 does not travel proximally past the stop 110.
- a distal end 116 of the increased diameter portion 112 abuts a shoulder formed on a distal end of the handle body 100 when the needle 60 is in a distal-most position.
- the needle actuator 75 when the needle actuator 75 is retracted to the proximal-most position, it can be rotated about the longitudinal axis of the housing 100 so that the needle actuator 75 is locked into a locking bay 118.
- Fig. 17 shows a device similar to that of Fig. 16 except that the increased diameter portion 112 of the needle 60 includes a detente 120 extending from the proximal end 114.
- This detente 120 cooperates with a latch 122 formed on a portion of the snare handle 90 extending within the housing 100 so that as the snare 80 is pushed distally, the latch 122 will abut the proximal end 114 of the increased diameter portion 112 pushing the needle 60 out to the fully deployed position.
- the needle 60 may be independently deployed by moving the needle handle 75 distally.
- the latch 122 moves underneath the detente 120 and locks the snare handle 90 to the needle 60.
- the needle 60 is also drawn back into the sheath 1 until further proximal travel of the needle 60 is stopped by contact between the distal end 114 and the stop 110 at which point the latch 122 is released from the detente 114 and the snare 80 is retracted into the interior lumen 70 of the needle 60.
Description
- The present invention relates generally to the field of tissue ligation, and more particularly to an improved device for severing lesions.
- A wide variety of lesions, including internal hemorrhoids, polyps, and mucositis, may be treated by severing snare ligation.
- In severing snare ligation, a targeted lesion is removed from the surrounding tissue by an electrosurgical severing snare using radio frequency (R/F) electric current to sever tissue or to achieve hemostasis. A high radio frequency is used (i.e., above 100,000 Hz.) to avoid the potentially injurious stimulation of muscles and nerves which results from lower frequency R/F energy. Thus, electrosurgery is typically performed at frequencies of approximately 500,000 Hz., although frequencies as high as 4,000,000 Hz. may be used.
- Medical diathermy is similar to electrosurgery in that radio frequency current is passed through the patient's body. The major difference between these two techniques is the density of the radio frequency electric current; the current density used in medical diathermy is kept low to reduce tissue heating and to prevent necrosis.
- There are three surgical effects that can be achieved with electrosurgery. These include electrosurgical desiccation, which is a low power coagulation caused without sparking to the tissue; electrosurgical cutting, where electricity sparks to the targeted tissue and produces a cutting effect; and electrosurgical fulguration, where electricity sparks to the targeted tissue without causing significant cutting.
- The above-described surgical effects can be accomplished by using either a monopolar or bipolar output. For many applications, however, bipolar outputs are preferable because the patient return electrode (necessary in monopolar procedures and a common source of accidents) is eliminated, and any desiccation performed is extremely localized because, in a true bipolar operation, only the tissue that is grasped between the two electrodes is desiccated. Bipolar output, however, is less effective for cutting and fulgurating, and thus monopolar tools remain commonplace. Severing snares, for example, are almost all monopolar instruments.
- In addition, three types of electrical current waveforms are typically used in electrosurgery. These include a "cutting" waveform, which cuts tissue very cleanly but may cause the incised tissue to bleed excessively; a "coagulating" waveform, which desiccates and fulgurates tissue without significant cutting; and a "blended" waveform, which is a cutting waveform that has a moderate hemostatic effect. A waveform's "Crest Factor" describes the degree of hemostasis that a waveform will produce if properly applied.
- To remove a lesion (or polyp) with an electrosurgical severing snare, the wire snare is looped around the targeted lesion and is tightened as the snare is drawn into the sheath. The lesion is then desiccated and cut through electrosurgically. It is also possible to sever a lesion in a single step by cutting with a "blended" current. This allows a snare to cut through a lesion in one pass without having to worry about bleeding. Alternately, the lesion may be cut through mechanically with a thin snare wire after the blood supply to the targeted tissue has been coagulated and the tissue has been softened by a desiccation current.
- Saline-Assisted Polypectomy (SAP), or "strip biopsy," has become an increasingly popular way of performing endoscopic mucosal resection (EMR) to diagnose and treat diseases of the gastrointestinal tract. When performing SAP, a surgeon passes a needle through an endoscope and inserts the needle into the submucosa layer proximate to the lesion. Next, the surgeon injects physiological saline into the submucosa to elevate the lesion on a bed of saline solution. Once elevated, the surgeon can easily remove the lesion by passing an electrosurgical severing snare over the lesion and ligating the lesion. SAP, however, typically requires the use of a large diameter double-channel endoscope, which is difficult to introduce into the patient and is hard to manipulate. In addition, grasping forceps must be used to lift the lesion off of the layer of saline solution, which may result in a tear in the mucosa.
- Accordingly, an alternate procedure has been developed called endoscopic aspiration mucosectomy (EAM). As described by Torii et al. in "Endoscopic Aspiration Mucosectomy as Curative Endoscopic Surgery," Gastrointestinal Endoscopy, Vol. 42, No. 5 (1995), EAM can be used to lift up a targeted lesion with suction, rather than with forceps, thereby reducing the risk of injury to the mucosal surface. When performing EAM, a double-channel endoscope is introduced into the patient, the lesion is marked with a needle knife, and saline solution or Glyceol™ (e.g., a hypertonic solution of 10% glycerol, 5% fructose, and physiological saline solution; available from Chugai Pharmaceutical Co., Tokyo, Japan) is injected into the submucosal layer beneath the lesion to separate the lesion from the layer. Next, the double-channel endoscope is withdrawn from the patient and a single-channel, video endoscope equipped with a transparent aspiration cylinder is introduced into the patient and (e.g., a Teflon® tube through which suction is applied) an electrosurgical severing snare is tightened around the outer circumference of the cylinder.
- Once the single-channel endoscope has been properly repositioned near the targeted lesion, the lesion and the surrounding mucosa are aspirated into the cylinder and the snare is pushed off the cylinder and tightened around the lesion to ligate the lesion. By first aspirating the lesion into the tube before severing it, the lesion may be severed further down on the stalk than possible with SAP. After the targeted lesion has been severed from the surrounding tissue, the severed tissue may remain aspirated into the cylinder to retrieve the sample for further study. Alternately, the severed tissue may be aspirated out of the cylinder to pass through the body naturally.
- However, while the EAM procedure described by Torii et al. may offer certain advantages over SAP, it still has its disadvantages. To perform EAM, a surgeon must switch between a double-channel endoscope having a needle knife and an injection needle (for marking the lesion and injecting-solution), and a more maneuverable single-channel endoscope having a severing snare and an aspiration cylinder(for ligating and aspirating the lesion) because the working channel of a single-channel endoscope cannot accommodate both an injection needle and a severing snare simultaneously. Alternately, as discussed by Torii et al., double-channel endoscopes are too large and are not desirable for the EAM procedure. Exchanging endoscopes, however, is time consuming - wasting surgeons' time and prolonging the procedure.
- United States Patent No. 5,542,948 to Weaver et al. as well as document WO 97/38630 purports to disclose an instrument in which a severing snare and an injection needle disposed side-by-side in separate lumens of the device are prevented from being simultaneously deployed by an actuator assembly which maintains one of the instruments (e.g., the severing snare) within the lumen until the other instrument (e.g., the injection needle) has been completely withdrawn into its respective lumen.
- This requires the use of a multi-lumen sheath including two lumens for carrying the injection needle and severing snare. However, multi-lumen sheaths take up valuable space and make the overall endoscopic apparatus large and bulky. The use of two lumens within a sheath also limits the size of the severing snare and injection needle that can be used, as the instruments are disposed through the sheath side-by-side.
- In addition, the depth at which a surgeon using the apparatus disclosed by Weaver et al. may sever a lesion is limited because the device is designed to be used when performing SAP and does not, therefore, provide for an aspirating device. This prevents the use of the device of Weaver et al. in performing EAM.
- The present invention is directed to a device for treating a lesion within a living body, comprising a sheath extending from a proximal end which, in an operative position, is located outside the body, to a distal end which, in the operative position is located within the body. A needle extending through the sheath defines a tissue piercing distal tip and a central lumen extends through the needle from a proximal port to a distal opening formed in the distal tip. A needle actuator is provided for moving the needle between a retracted position in which the distal tip is received within the sheath to an injection position in which the distal tip extends distally beyond a distal end of the sheath and a snare extends within the lumen to a loop formed in a distal end of the snare. A snare actuator is provided for moving the snare between a covered position in which the loop is received within the lumen and an extended position in which the loop extends distally from the lumen beyond the distal tip.
- The invention will be more readily understood through the following detailed description, with reference to the accompanying drawings, in which:
- Fig. 1 shows an apparatus according to the embodiment of the present invention alongside a aspiration cylinder and a distal end of an endoscope;
- Fig. 2 shows the apparatus according to the present embodiment with both a needle handle and a snare handle fully-deployed;
- Fig. 3 shows the apparatus according to the present embodiment with both the needle handle and the snare handle partially-deployed;
- Fig. 4 shows the apparatus according to the present embodiment with the needle handle fully-deployed and the snare handle fully-retracted;
- Fig. 5 shows the apparatus according to the present embodiment, arranged as seen in Fig. 4, passing through an endoscope to which a aspiration cylinder has been coupled;
- Fig. 6 shows the apparatus according to the present embodiment, arranged as seen in Fig. 5, with the needle retracted and the snare extended and pressing against a lesion;
- Fig. 7 shows prior art apparatus which does not make part of the present invention wherein the needle and the snare are located external to the working channel of the endoscope, and the sheath is attached to the aspiration cylinder;
- Fig. 8 shows the apparatus according to the present embodiment located adjacent to a targeted lesion;
- Fig. 9 shows the apparatus according to the present embodiment with the needle injecting a sclerotherapy agent between the mucosa and the muscularis propria;
- Fig. 10 shows the apparatus according to the present embodiment with the snare being maneuvered over the targeted lesion while the lesion and the surrounding mucosa are aspirated through the inner diameter of the snare into the aspiration cylinder;
- Fig. 11 shows the apparatus according to the present embodiment with the snare being pulled tightly around the targeted lesion;
- Fig. 12 shows the apparatus according to the present embodiment with the targeted lesion being ligating by the severing snare;
- Fig. 13 shows the apparatus according to the present embodiment with the now-severed lesion aspirated into the aspiration cylinder;
- Fig. 14 shows a cross section of the apparatus of Fig. 1;
- Fig. 15 shows the apparatus of Fig. 1 with the needle and the snare in fully retracted positions;
- Fig. 16 shows a cross-section of an additional embodiment of the invention including a stop for limiting the movement of the snare and needle; and
- Fig. 17 shows a cross-section of a further embodiment including a mechanism for latching the snare and needle together so that they may be retracted in unison.
- As shown in Fig. 1, an apparatus according to a first embodiment of the invention comprises a
sheath 1, having aproximal end 5 and a distal end 10. Alumen 15 extends between the proximal anddistal ends 5 and 10, and may preferably have a substantially circular cross-section. A distal aperture 20 is defined at the point where thelumen 15 exits the distal end 10 of thesheath 1. - The
sheath 1 is designed to pass through the workingchannel 30 of anendoscope 25. The workingchannel 30 extends within theendoscope 25 from an accessible end (not shown) to a workingend 35 of theendoscope 25. The workingchannel 30 is sized to allow the free passage of instruments therethrough from an opening formed in the accessible end into the workingchannel 30 to the workingend 35. Of course those skilled in the art will understand that different scopes have workingchannels 30 of various diameters and that it is necessary only to size thesheath 1 so that a sufficient clearance is preserved within the channel so that thesheath 1 may freely pass through the workingchannel 30. Of course, when thesheath 1 extends outside theendoscope 25, the size of the workingchannel 30 is not a factor in determining the size of thesheath 1. - To configure the
endoscope 35 for use with the apparatus according to the invention,aspiration cylinder 40cylinder 40 is coupled to the workingend 35 of theendoscope 25. Theaspiration cylinder 40, which may preferably be constructed of a transparent bio-compatible plastic such as, for example, polycarbonate or lexan, includes adistal end 45, which defines adistal aperture 50 and an aspiratingchamber 55. The aspiratingchamber 55 is in communication with the workingchannel 30 of theendoscope 25 so that an instrument, such as that according to the first embodiment of the present invention, may be passed through the workingchannel 30, through the aspiratingchamber 55, and through thedistal aperture 50 of theaspiration cylinder 40. -
Endoscope 25 is preferably a single-channel endoscope. Alternately, the surgeon may use a multiple-channel endoscope and use one or more of the other working channels for advancing an instrument, such as a forceps 200 (shown in Fig. 7), basket, needle, or other device, through theendoscope 25, or for accommodating a fiber optical system (not shown). The length of theendoscope 25 should be sufficient to allow the surgeon to use theendoscope 25 and the attachedaspiration cylinder 40 to reach the targeted lesions within the patient's body. - An
injection needle 60 is disposed through thelumen 15 of thesheath 1. Theinjection needle 60 defines alumen 70, which terminates in adistal aperture 67, and has a proximal end (not shown) and adistal tip 65. The cross-sections of theinjection needle 60 and thelumen 70 are preferably generally circular, and the cross-sectional diameter of theinjection needle 60 is less than the diameter of thelumen 15 of thesheath 1, through which theinjection needle 60 passes. As the cross-sectional diameter of theinjection needle 60 is less than the diameter of thelumen 15 of thesheath 1, theinjection needle 60 is free to move longitudinally through thelumen 15. - The proximal end of the
injection needle 60 is connected to aninjection needle handle 75, which slidably engages ahandle body 100. Theinjection needle handle 75, which includes aninjection port 77, may be moved longitudinally along thehandle body 100 from a fully-deployed position (shown in Fig. 4), wherein the injection needle handle 75 is positioned proximate to the distal end 105 (formed as a thumb handle) of thehandle body 100, to a fully-retracted position (shown in Fig. 6), wherein the injection needle handle 75 has been moved away from thedistal end 105 of thehandle body 100 relative to the fully-deployed position. However, if the snare handle 90 is moved further proximally, the needle handle 75 may also be moved further proximally to further retract theneedle 75. In the preferred embodiment of the invention, it is also contemplated that the injection needle handle 75 may be positioned in any number of positions between the fully-deployed and fully-retracted positions. - Movement of the injection needle handle 75 controls and limits the movement of the
injection needle 60 through thelumen 15 of thesheath 1. When the injection needle handle 75 is in the fully-deployed position, thedistal tip 65 of theinjection needle 60 extends through and beyond the distal aperture 20 of the sheath 1 (as seen in Figs. 2 and 3). When the present invention is used with anendoscope 25 and aaspiration cylinder 40, thedistal tip 65 of theinjection needle 60 will extend beyond thedistal aperture 50 of theaspiration cylinder 40 when the injection needle handle 75 is in the fully-deployed position and thesheath 1 is properly positioned, either within the endoscope 25 (as seen in Fig. 5) or outside the endoscope 25 (as seen in Fig. 7), for carrying out the desired procedure. When the injection needle handle 75 is in a mid-range (as seen in Fig. 3) or a fully-retracted position (as seen in Fig. 6), thedistal tip 65 of theinjection needle 60 is completely withdrawn within thelumen 15 of thesheath 1. By completely retracting theinjection needle 60 within thesheath 1 when theinjection needle 60 is not in use, a surgeon can substantially reduce the risk of accidental perforation or entanglement. - An
electrosurgical severing snare 80 is disposed within thelumen 70 of theinjection needle 60. The severingsnare 80 has a proximal end (not shown) and adistal loop 85, which is flexible and made of light-gauge wire such as nitinol or stainless steel. The severingsnare 80 is preferably not surrounded by any insulating material so that, when r/f energy is supplied to the severingsnare 80, theinjection needle 60 is also "hot." However, thesheath 1 is preferably formed as an insulator to guard against short circuiting with an interior surface of the workingchannel 30 and to protect tissue surrounding the lesion from damage prior to locating a final position and deploying a desired one of theneedle 60 and thesnare 80. Thus, theneedle 60 may be used to cauterize bleeding vessels, or may serve as a point electrical surgery knife. - The diameter of the severing
snare 80, the cross-section of which is preferably generally circular, is less than the diameter of thelumen 70 of theinjection needle 60, through which the severingsnare 80 passes. Those skilled in the art will understand that, because two strands of the wire of thedistal loop 85 or the severingsnare 80 are received within the distal end of thelumen 70, it is preferable to select a light-gauge wire which is less than half the diameter of thelumen 70. As the cross-sectional diameter of the severingsnare 80 is less than the diameter of thelumen 70, the severingsnare 80 is free to move longitudinally through thelumen 70. The proximal end of the severingsnare 80 is connected to asnare handle 90, which slidably engages thehandle body 100, and is in electrical communication with an R/F snare plug 95. Snare handle 90 may be moved longitudinally along thehandle body 100 between a fully-deployed position, (shown in Figs. 2 and 3) in which thedistal loop 85 extends from the distal end of thelumen 70, wherein the snare handle 90 is close to thedistal end 105 of thehandle body 100, and a fully-retracted position (shown in Fig. 4), in which thedistal loop 85 is completely retracted into thelumen 70, wherein the snare handle 90 is located adjacent to thethumb ring 105 of thehandle body 100. In the preferred embodiment of the invention, it is also contemplated that the snare handle 90 may be positioned in any number of positions between the fully-deployed and fully-retracted positions. - Movement of the snare handle 90 controls and limits the movement of the severing
snare 80 through thelumen 70 of theinjection needle 60. When the snare handle 90 is in the fully-deployed position, thedistal loop 85 of the severingsnare 80 extends through and beyond thedistal aperture 67 of theinjection needle 60. When the present invention is used with anendoscope 25 and aaspiration cylinder 40, thedistal loop 85 of the severingsnare 80 will extend beyond thedistal aperture 50 of theaspiration cylinder 40 when the snare handle 90 is in the fully-deployed position, and theinjection needle 60 andsheath 1 are properly positioned, either within the endoscope 25 (as seen in Fig. 6) or outside the endoscope 25 (as seen in Fig. 6), for carrying out the desired procedure. - When the snare handle 90 is in the fully-retracted position, the
distal loop 85 of the severingsnare 80 is completely withdrawn and collapsed within thelumen 70 of theinjection needle 60. Of course, theloop 85 will initially be compressed when it is drawn into thesheath 1 and, by drawing theneedle 60 proximally along with thesnare loop 85, a user can ensure that thesnare loop 85 is collapsed by thesheath 1 before being retracted into thelumen 70. By completely retracting thedistal loop 85 and the severingsnare 80 within thelumen 70, a surgeon can substantially reduce the risk of accidentally having another instrument, such as a forceps 200 (shown in Fig. 7) become entangled in thedistal loop 85. Thedistal loop 85 of the severingsnare 80 is also protected from being accidentally perforated by theinjection needle 60 by the fact that thedistal loop 85 is located distal to theinjection needle 60. - For each of the above-described embodiments, when fully-extended and not deformed by another object, the
distal loop 85 defines a generally elliptical area, which can be referred to as having alength 1 and a width w. When thedistal loop 85 is retracted into thelumen 70 of the injection needle 60 (i.e., "collapsed"), width w is reduced to approximately the diameter of thelumen 70. Accordingly, the area defined by thedistal loop 85 is substantially smaller after thedistal loop 85 has been collapsed than before it has been collapsed.Distal loop 85 is able to be collapsed upon being retracted because the wire that comprises thedistal loop 85 is flexible. Thedistal loop 85 is preferably biased so that, when thedistal loop 85 is redeployed it will return to its precollapsed state and define roughly the same area as it did before it was collapsed within thelumen 70. In addition as shown in Figs. 11 and 12, thesnare loop 85 may be biased so that, when outside thelumen 70, theloop 85 extends in a plane disposed at an angle, e.g., 90°, relative to the longitudinal axis of theneedle 60. That is, theloop 85 may be biased so that, when deployed, it extends across an opening of theaspiration cylinder 40. This facilitates placement of theloop 85 over a lesion aspirated into theaspiration cylinder 40. - The R/F snare plug 95 is provided to transmit energy from an external source (not shown) to the
distal loop 85 of the severingsnare 80. - In the preferred embodiment of the invention, the
sheath 1 is designed to pass through the workingchannel 30 of theendoscope 25. By using the device in this manner, the overall cross-sectional area of the endoscope is not increased due to the presence of thesheath 1,injection needle 60, and severingsnare 85, although theaspiration cylinder 40 may slightly increase the profile of theendoscope 25. Furthermore, because the severingsnare 80 is coaxial with theinjection needle 60, the combination of the two instruments takes up approximately the same amount of room within the workingchannel 30 that a standard injection needle would. - If, however, the
injection needle 60 and the severingsnare 80 were positioned side-by-side and electrically isolated from one another by separate sheaths, the combination of the two instruments would require more room within the workingchannel 30, thereby necessitating the use by the surgeon of a large endoscope or the elimination of the advantages of having both instruments simultaneously present at the site of the lesion and, instead, having to perform several "exchanges" as discussed in the prior art. - Thus, a surgeon using the present device may use an endoscope with a relatively small working
channel 30 while still enjoying the benefits of locating both aninjection needle 60 and a severingsnare 80 simultaneously at the site of a lesion. Alternately, the surgeon may use any "free space" within an larger diameter endoscope (such as the diameter that would be needed if the two instruments were positioned side-by-side) for passing other instruments, such as aforceps 200, through the workingchannel 30. Also, the surgeon could select aninjection needle 60 and a severingsnare 80 having slightly larger diameters, thereby allowing for more injection flow through theinjection needle 60 and for astronger severing snare 80. - In an alternate embodiment which is not part of the present invention as shown in Fig. 7, the
sheath 1 may be located external to the workingchannel 30 of a relativelysmall diameter endoscope 25. In such a configuration, a portion of thesheath 1 is attached to theaspiration cylinder 40 by tape, cable ties, or mesh means (not shown). While this configuration enlarges the overall profile of theendoscope 25 andaspiration cylinder 40 assembly, the surgeon is then free to use another instrument, such as aforceps 200, basket, needle, or cautery device, through the workingchannel 30 of theendoscope 25, without having to first remove theinjection needle 60 and the severingsnare 80 from the patient. The open workingchannel 30 of theendoscope 25 also allows for multiple combinations of instruments to be used within the workingchannel 30 without having to remove theendoscope 25 from the body of the patient. - The method for ligating a lesion described with reference to Figs. 8-13, is only for elucidating purposes and does not make part of the present invention.
- First, a surgeon administers a local pharyngeal anesthesia or general anesthesia to the patient and introduces into the patient an
endoscope 25 having anaspiration cylinder 40 coupled thereto. The surgeon then passes thesheath 1 through the workingchannel 30 of theendoscope 25 with thesheath 1 protecting the endoscope from being scraped or damaged by the needle as it is passed through the workingchannel 30. Aneedle 60 is passed through thelumen 15 of thesheath 1 with a severingsnare 80 disposed within thelumen 70 of theneedle 60. Alternately, the surgeon may forgo use of aaspiration cylinder 40 and may attach thesheath 1 to the outside of theendoscope 25. - As shown in Fig. 8, the surgeon positions the distal end of the
aspiration cylinder 40 adjacent to thelesion 205 that the surgeon wishes to remove. Thelesion 205 as shown in Figs. 8-13 is illustrative of a lesion found in the gastrointestinal tract and may, for example, be associated with early gastric cancer or adenoma. Thelesion 205 is part of themucosa 210, and is positioned over a submucosa layer 215 (the muscularis propria). - Next, the surgeon passes an injection needle 60 (shown in Fig. 9) through the
mucosa 210, and injects a sclerotherapy agent L or saline solution between themucosa 210 and the muscularis propria 215, thereby separating themucosa 210 from the muscularis propria 215. It is preferable that a sclerotherapy agent L, such as Glyceol™, be used rather than saline solution because the bulge formed between themucosa 210 andmuscularis propria 215 lasts longer when a sclerotherapy agent is used. - Once the
lesion 205 has been elevated on a bed of sclerotherapy agent L, the surgeon deploys thesnare 80 and positions theloop 85 around thelesion 205 and then aspirates thelesion 205 through theloop 85 into the aspiratingchamber 55 of the aspiration cylinder 40 (shown in Fig. 10) and tightens theloop 85 around the tissue to sever the lesion 205 (shown in Fig. 12). - If the surgeon is using an electrosurgical severing snare, as described in the background of the invention, he would apply the appropriate R/F energy (i.e., "cutting," "coagulating," or "blended") to the snare through an R/F snare plug 95 while severing the
lesion 205. As shown in Fig. 13, after thelesion 205 has been severed, it may be retained in theaspiration cylinder 40 to be removed from the body for further pathology study or aspirated out of the aspiratingchamber 55 to pass through the body. If thelesion 205 is aspirated out of theaspiration cylinder 40, the surgeon may immediately proceed to treat a subsequent lesion (not shown) without having to remove theendoscope 25 and theaspiration cylinder 40 from the body. - Alternately, the surgeon may pass an instrument, such as a
forceps 200, through the workingchannel 30 or an external or an addition lumen (not shown) of theendoscope 25 to grasp and retrieve thelesion 205. If thesheath 1 occupies the workingchannel 30 and no other lumen is provided, then the surgeon could exchangesheath 1 for the desiredinstrument 200, or attempt to pass theinstrument 200 around thesheath 1 within the workingchannel 30. This exchange would be eliminated, however, if thesheath 1 were connected to the outside of the aspiration cylinder 40 (as seen in Fig. 7), thereby freeing up the workingchannel 30 of theendoscope 25 for other instruments, such as theforceps 200. - In addition, if the surgeon opts not to perform EAM and instead elects for SAP, the
forceps 200, rather than suction, would be used to separate thelesion 205 and themucosa 210 from the muscularis propria 215. Accordingly, it would be desirable to adapt the present invention to allow for both thecoaxial needle 60 / severingsnare 80 instrument and theforceps 200 to be simultaneously located at the site of thelesion 205. In accordance with an alternate embodiment of the present invention, thesheath 1 could be located external to theendoscope 25, thereby still allowing the surgeon to use a single-channel (rather than a double-channel)endoscope 25 to perform the SAP procedure. - Those skilled in the art will understand that the injection needle handle 75 is preferably coupled to the severing snare handle 90 so that, when the severing
snare 80 is retracted, theinjection needle 60 is also retracted at least until thedistal tip 65 of the injection needle-60 is received within thesheath 1. For example, after grasping tissue, the diameter of thedistal loop 85 will be expanded to surround the tissue and, when thesnare 80 is retracted while theinjection needle 60 is fully or partially deployed, the expandedloop 85 will be too large to enter theinjection needle 60. Thus, theneedle 60 will be pushed proximally by the proximal travel of thedistal loop 85 until the severingloop 85 comes into contact with the distal end 10 of thesheath 1. As shown in Fig. 14, as thesnare 80 is drawn further into thesheath 1, decreasing the diameter of thedistal loop 85, there is no impediment to the proximal travel of theneedle 60 which is pushed further proximally into thehousing 100. Fig. 15 shows the apparatus of Fig. 14 in which nostop 110 is provided to limit the proximal travel of theneedle 60, wherein both thesnare 80 and theneedle 60 are completely withdrawn into thesheath 1. - Fig. 16 shows a further embodiment of the apparatus according to the present invention in which a mechanism is provided to control the motion of the
needle 60 and thesnare 80. Specifically, the apparatus of Fig. 16 includes astop 110 formed as a rod extending across the interior lumen of thehandle body 100 preferably substantially perpendicular to a longitudinal axis of thehandle body 100. Thestop 110 contacts the snare handle 90 to define the distal-most position of the snare handle 90 and, consequently, the distal-most position of thesnare 80. Similarly, thestop 110 contacts the needle handle 75 to define the proximal-most position of theneedle handle 75 and, consequently, of theneedle 60. Those skilled in the art will understand that therod 110 may be formed as a separate piece bonded to, or molded into, the interior of thehandle body 100. In addition, an increaseddiameter portion 112 of theneedle 60 is provided to further define the proximal and distal limits of travel of theneedle 60. Specifically, theproximal end 114 of the increaseddiameter portion 112, which is formed as a seal to seal theinterior lumen 70 of theneedle 60, facilitates contact between thestop 110 and theneedle 60 and includes a receivingcavity 113 to ensure that theneedle 60 does not travel proximally past thestop 110. Adistal end 116 of the increaseddiameter portion 112 abuts a shoulder formed on a distal end of thehandle body 100 when theneedle 60 is in a distal-most position. In addition, when theneedle actuator 75 is retracted to the proximal-most position, it can be rotated about the longitudinal axis of thehousing 100 so that theneedle actuator 75 is locked into a lockingbay 118. - Fig. 17 shows a device similar to that of Fig. 16 except that the increased
diameter portion 112 of theneedle 60 includes adetente 120 extending from theproximal end 114. Thisdetente 120 cooperates with alatch 122 formed on a portion of the snare handle 90 extending within thehousing 100 so that as thesnare 80 is pushed distally, thelatch 122 will abut theproximal end 114 of the increaseddiameter portion 112 pushing theneedle 60 out to the fully deployed position. Of course, theneedle 60 may be independently deployed by moving the needle handle 75 distally. In any case, when theneedle 60 reaches the fully deployed position and thedistal end 116 abuts the shoulder formed on the distal end of thehandle body 100, thelatch 122 moves underneath thedetente 120 and locks the snare handle 90 to theneedle 60. Thus, when thesnare 80 is withdrawn proximally, theneedle 60 is also drawn back into thesheath 1 until further proximal travel of theneedle 60 is stopped by contact between thedistal end 114 and thestop 110 at which point thelatch 122 is released from thedetente 114 and thesnare 80 is retracted into theinterior lumen 70 of theneedle 60.
Claims (10)
- A device for treating a lesion within a living body, comprising:a sheath (1) extending from a proximal end (5) which, in an operative position, is located outside the body, to a distal end (10) which, in the operative position is located within the body;a needle (60) extending through the sheath (1), wherein a distal end of the needle (60) defines a tissue piercing distal tip (65) and a central lumen (70) extends through the needle (60) from a proximal port (77) to a distal opening (67) formed in the distal tip (65);a snare (80) extending within the lumen (70) to a loop (85) formed in a distal end of the snare (80);a needle actuator (75) for moving the needle (60) between a retracted position in which the distal tip (65) is received within the sheath (1) to an injection position in which the distal tip (65) extends distally beyond the distal end (10) of the sheath (1), anda snare actuator (90) for moving the snare (80) between a covered position in which the loop (85) is received within the lumen (70) and an extended position in which the loop (85) extends distally from the lumen (70) beyond the distal tip (65).
- The device according to claim 1, further comprising a handle (100) coupled to the proximal end (5) of the sheath (1), wherein the snare actuator (90) and the needle actuator (75) are coupled to the handle (100).
- The device according to claim 1 or 2, wherein the needle actuator (75) is selectively couplable to the snare actuator (90) so that, when the snare actuator (90) is moved from the extended position to the covered position and the needle (60) is in the injection position, the needle (60) is moved from the injection position to the retracted position.
- The device according to one of claims 1 to 3, wherein the sheath (1) is sized to be slidably received within a working channel (30) of an endoscope (25).
- The device according to one of claims 1 to 3, wherein the sheath (1) is adapted to be coupled to an outer surface of an endoscope (25).
- The device according to one of claims 1 to 5, wherein the snare (80) comprises an electrically conductive material and wherein a proximal end of the snare (80) is coupled to a contact (95) for coupling the snare (80) to a source of R/F energy.
- The device according to one of claims 2 to 6, wherein the handle (100) includes a snare locking mechanism (122) for locking the snare actuator (90) in a desired position wherein the desired position may be one of the covered position, the extended position and any position intermediate between the covered and extended positions.
- The device according to one of claims 2 to 7, wherein the handle (100) includes a needle locking mechanism (118) for locking the needle actuator (75) in a desired position wherein the desired position may be one of the retracted position, the injection position and any position intermediate between the retracted and injection positions.
- The device according to one of claims 4 to 8, further comprising an aspiration housing (40) connected to a distal end (35) of the endoscope (25).
- The device according to claim 9, wherein the sheath (1) extends into the aspiration housing (40) and wherein the needle (60) and the snare (80) may be extended into and retracted from the aspiration housing (40).
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US25499 | 1998-02-18 | ||
US09/025,499 US5961526A (en) | 1998-02-18 | 1998-02-18 | Coaxial needle and severing snare |
PCT/US1999/001253 WO1999042041A1 (en) | 1998-02-18 | 1999-01-21 | Coaxial needle and severing snare |
Publications (2)
Publication Number | Publication Date |
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EP1056400A1 EP1056400A1 (en) | 2000-12-06 |
EP1056400B1 true EP1056400B1 (en) | 2007-02-28 |
Family
ID=21826432
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP99903249A Expired - Lifetime EP1056400B1 (en) | 1998-02-18 | 1999-01-21 | Coaxial needle and severing snare |
Country Status (6)
Country | Link |
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US (2) | US5961526A (en) |
EP (1) | EP1056400B1 (en) |
JP (1) | JP4246389B2 (en) |
CA (1) | CA2320885A1 (en) |
DE (1) | DE69935315T2 (en) |
WO (1) | WO1999042041A1 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
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Families Citing this family (112)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
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US6511492B1 (en) * | 1998-05-01 | 2003-01-28 | Microvention, Inc. | Embolectomy catheters and methods for treating stroke and other small vessel thromboembolic disorders |
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US6221039B1 (en) * | 1998-10-26 | 2001-04-24 | Scimed Life Systems, Inc. | Multi-function surgical instrument |
US6371963B1 (en) * | 1998-11-17 | 2002-04-16 | Scimed Life Systems, Inc. | Device for controlled endoscopic penetration of injection needle |
US6162209A (en) * | 1998-11-17 | 2000-12-19 | Scimed Life Systems, Inc. | Multi-function surgical instrument tool actuator assembly |
US6488689B1 (en) | 1999-05-20 | 2002-12-03 | Aaron V. Kaplan | Methods and apparatus for transpericardial left atrial appendage closure |
JP2001192336A (en) * | 2000-01-11 | 2001-07-17 | Hironori Yamamoto | Endoscopic demucosation using highly viscous substance |
US6482184B1 (en) * | 2000-09-29 | 2002-11-19 | Advanced Infusion, Inc. | Attachable catheter |
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WO2002056914A1 (en) * | 2001-01-19 | 2002-07-25 | Hironori Yamamoto | Injections for endoscopy |
US7137988B2 (en) * | 2001-03-03 | 2006-11-21 | Frye Darrin L | Needle driver |
US7097644B2 (en) | 2001-03-30 | 2006-08-29 | Ethicon Endo-Surgery, Inc. | Medical device with improved wall construction |
US6918906B2 (en) | 2001-03-30 | 2005-07-19 | Gary L. Long | Endoscopic ablation system with improved electrode geometry |
US6814739B2 (en) * | 2001-05-18 | 2004-11-09 | U.S. Endoscopy Group, Inc. | Retrieval device |
US7169167B2 (en) * | 2001-12-04 | 2007-01-30 | Scimed Life Systems, Inc. | Endoscopic apparatus and method |
US7137981B2 (en) | 2002-03-25 | 2006-11-21 | Ethicon Endo-Surgery, Inc. | Endoscopic ablation system with a distally mounted image sensor |
JP4109092B2 (en) * | 2002-11-21 | 2008-06-25 | オリンパス株式会社 | High frequency knife |
JP4137610B2 (en) | 2002-11-25 | 2008-08-20 | オリンパス株式会社 | Incision tool |
US20040259646A1 (en) * | 2003-01-16 | 2004-12-23 | Clark Michael E. | Nested toys depicting likeness of celebrities and sports personalities and manufacturing method |
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US7842028B2 (en) * | 2005-04-14 | 2010-11-30 | Cambridge Endoscopic Devices, Inc. | Surgical instrument guide device |
JP4568911B2 (en) * | 2003-12-15 | 2010-10-27 | 学校法人日本大学 | Bone cutting device |
US8088139B2 (en) * | 2004-02-17 | 2012-01-03 | Boston Scientific Scimed, Inc. | Endoscopic tissue stabilization device and related methods of use |
JP4977017B2 (en) * | 2004-05-25 | 2012-07-18 | ユー.エス. エンドスコピー グループ, インコーポレイテッド | Snare injection device |
US7533439B2 (en) * | 2004-06-25 | 2009-05-19 | Healthy Gain Investments Limited | Handle assembly for a cleaning apparatus |
US7232438B2 (en) | 2004-07-09 | 2007-06-19 | Ethicon Endo-Surgery, Inc. | Ablation device with clear probe |
US7905857B2 (en) | 2005-07-11 | 2011-03-15 | Covidien Ag | Needle assembly including obturator with safety reset |
US7828773B2 (en) | 2005-07-11 | 2010-11-09 | Covidien Ag | Safety reset key and needle assembly |
US7850650B2 (en) | 2005-07-11 | 2010-12-14 | Covidien Ag | Needle safety shield with reset |
US8216234B2 (en) * | 2004-11-10 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Tissue resection device |
US8070756B2 (en) | 2005-04-15 | 2011-12-06 | U.S. Endoscopy Group, Inc. | Polypectomy device and method of use |
US8287535B2 (en) * | 2005-05-11 | 2012-10-16 | Mayo Foundation For Medical Education And Research | Apparatus and methods for internal surgical procedures |
US20060276747A1 (en) | 2005-06-06 | 2006-12-07 | Sherwood Services Ag | Needle assembly with removable depth stop |
US7731692B2 (en) | 2005-07-11 | 2010-06-08 | Covidien Ag | Device for shielding a sharp tip of a cannula and method of using the same |
US8409175B2 (en) * | 2005-07-20 | 2013-04-02 | Woojin Lee | Surgical instrument guide device |
WO2007014313A2 (en) * | 2005-07-26 | 2007-02-01 | Precision Thoracic Corporation | Minimally invasive methods and apparatus |
CA2617317A1 (en) * | 2005-08-04 | 2007-02-15 | C.R. Bard, Inc. | Systems for introducing implants |
JP2009515564A (en) * | 2005-08-04 | 2009-04-16 | シー・アール・バード・インコーポレイテツド | Pelvic implant system and method |
CA2617167A1 (en) * | 2005-08-04 | 2007-02-15 | C.R. Bard, Inc. | Implant introducer |
US20070118099A1 (en) * | 2005-08-15 | 2007-05-24 | Trout Hugh H Iii | Method and apparatus for endovascular graft cutting |
US7789881B2 (en) | 2005-08-25 | 2010-09-07 | Boston Scientific Scimed, Inc. | Endoscopic resection method |
JP4763420B2 (en) * | 2005-10-27 | 2011-08-31 | オリンパスメディカルシステムズ株式会社 | Endoscope operation assistance device |
US7654735B2 (en) | 2005-11-03 | 2010-02-02 | Covidien Ag | Electronic thermometer |
WO2007059199A2 (en) | 2005-11-14 | 2007-05-24 | C.R. Bard, Inc. | Sling anchor system |
AU2006332514B2 (en) * | 2005-12-28 | 2013-01-17 | C.R. Bard, Inc. | Apparatus and method for introducing implants |
US20090318752A1 (en) * | 2006-03-15 | 2009-12-24 | C. R. Bard, Inc. | Implants for the treatment of pelvic floor disorders |
CA2648434C (en) * | 2006-04-13 | 2011-08-09 | Wilson-Cook Medical Inc. | Apparatus and methods for endoscopic resection of tissue |
US7651491B2 (en) * | 2006-04-28 | 2010-01-26 | Ethicon Endo-Surgery, Inc. | Method for performing an endoscopic mucosal resection |
US7867228B2 (en) * | 2006-04-28 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Apparatus and method for performing an endoscopic mucosal resection |
US20070255278A1 (en) * | 2006-04-28 | 2007-11-01 | Nobis Rudolph H | Apparatus and method for deploying a cutting element during an endoscopic mucosal resection |
US20070270643A1 (en) * | 2006-05-19 | 2007-11-22 | Ifung Lu | Lumen stabilizer for endoscopic mucosal resection |
US8105350B2 (en) | 2006-05-23 | 2012-01-31 | Cambridge Endoscopic Devices, Inc. | Surgical instrument |
JP4767761B2 (en) | 2006-06-05 | 2011-09-07 | 直久 矢作 | High frequency treatment tool |
US8029531B2 (en) * | 2006-07-11 | 2011-10-04 | Cambridge Endoscopic Devices, Inc. | Surgical instrument |
US8480559B2 (en) | 2006-09-13 | 2013-07-09 | C. R. Bard, Inc. | Urethral support system |
US20080091190A1 (en) * | 2006-10-17 | 2008-04-17 | Tyco Healthcare Group Lp | Injectable surgical patch and method for performing same |
US8221443B2 (en) * | 2006-11-15 | 2012-07-17 | Mayo Foundation For Medical Education And Research | Submucosal endoscopy with mucosal flap methods and kits |
US20080125782A1 (en) * | 2006-11-29 | 2008-05-29 | Disc Dynamics, Inc. | Method and apparatus for removing an extension from a prosthesis |
US20080262492A1 (en) * | 2007-04-11 | 2008-10-23 | Cambridge Endoscopic Devices, Inc. | Surgical Instrument |
JP2008301968A (en) * | 2007-06-06 | 2008-12-18 | Olympus Medical Systems Corp | Endoscopic image processing apparatus |
US8591521B2 (en) | 2007-06-08 | 2013-11-26 | United States Endoscopy Group, Inc. | Retrieval device |
US20100217151A1 (en) * | 2007-07-11 | 2010-08-26 | Zach Gostout | Methods and Systems for Performing Submucosal Medical Procedures |
US8929988B2 (en) | 2007-07-11 | 2015-01-06 | Apollo Endosurgery, Inc. | Methods and systems for submucosal implantation of a device for diagnosis and treatment of a body |
US8317771B2 (en) | 2007-07-11 | 2012-11-27 | Apollo Endosurgery, Inc. | Methods and systems for performing submucosal medical procedures |
US8066689B2 (en) | 2007-07-11 | 2011-11-29 | Apollo Endosurgery, Inc. | Methods and systems for submucosal implantation of a device for diagnosis and treatment with a therapeutic agent |
US8128592B2 (en) | 2007-07-11 | 2012-03-06 | Apollo Endosurgery, Inc. | Methods and systems for performing submucosal medical procedures |
JP4726016B2 (en) * | 2007-07-19 | 2011-07-20 | 有限会社リバー精工 | High frequency electric knife for endoscope |
US20090043317A1 (en) * | 2007-08-08 | 2009-02-12 | Cavanaugh Brian J | Method and apparatus for delivery of a ligating suture |
US8357104B2 (en) | 2007-11-01 | 2013-01-22 | Coviden Lp | Active stylet safety shield |
US8206280B2 (en) | 2007-11-13 | 2012-06-26 | C. R. Bard, Inc. | Adjustable tissue support member |
US8435237B2 (en) | 2008-01-29 | 2013-05-07 | Covidien Lp | Polyp encapsulation system and method |
US20090287045A1 (en) | 2008-05-15 | 2009-11-19 | Vladimir Mitelberg | Access Systems and Methods of Intra-Abdominal Surgery |
US8465456B2 (en) * | 2008-07-31 | 2013-06-18 | Boston Scientific Scimed, Inc. | Extendable aspiration catheter |
DE102009002768A1 (en) * | 2009-04-30 | 2010-11-04 | Celon Ag Medical Instruments | Material layer and electrosurgical system for electrosurgical tissue fusion |
US10363087B2 (en) * | 2009-10-12 | 2019-07-30 | Apollo Endosurgery Us, Inc. | Tissue resection device |
US20110306992A1 (en) | 2010-06-09 | 2011-12-15 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures, transfascial suture assemblies, and methods of transfascial suturing |
EP2658456B1 (en) | 2010-12-30 | 2014-11-26 | Boston Scientific Scimed, Inc. | Snare with retractable engaging members |
EP2661233A4 (en) * | 2011-01-04 | 2014-09-03 | Merit Medical Systems Inc | Multiple loop snare |
EP3964146B1 (en) | 2011-01-31 | 2023-10-18 | Boston Scientific Scimed Inc. | Medical devices having releasable coupling |
CA2831898A1 (en) | 2011-04-06 | 2012-10-11 | Medrobotics Corporation | Articulating surgical tools and tool sheaths, and methods of deploying the same |
US9039713B2 (en) | 2011-05-13 | 2015-05-26 | Merit Medical Systems, Inc. | Releasably attached snare loop retrieval device and method of using the same |
US9826972B2 (en) | 2011-10-24 | 2017-11-28 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures, transfascial suture assemblies and methods of transfascial suturing |
US9078648B2 (en) | 2011-11-07 | 2015-07-14 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures and methods of transfascial suturing |
US9039721B2 (en) | 2011-11-07 | 2015-05-26 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures and methods of transfascial suturing |
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WO2014189876A1 (en) | 2013-05-20 | 2014-11-27 | Medrobotics Corporation | Articulating surgical instruments and method of deploying the same |
US9572591B2 (en) | 2013-09-03 | 2017-02-21 | United States Endoscopy Group, Inc. | Endoscopic snare device |
US10292571B2 (en) | 2015-02-23 | 2019-05-21 | Uroviu Corporation | Handheld surgical endoscope with wide field of view (FOV) and illumination brightness adjusted by area within the FOV |
US10869592B2 (en) | 2015-02-23 | 2020-12-22 | Uroviu Corp. | Handheld surgical endoscope |
US10524636B2 (en) | 2015-02-23 | 2020-01-07 | Uroviu Corp. | Handheld surgical endoscope |
WO2016137838A1 (en) | 2015-02-23 | 2016-09-01 | Xiaolong Ouyang | Handheld surgical endoscope |
US20160331343A1 (en) * | 2015-05-11 | 2016-11-17 | Veran Medical Technologies, Inc. | Medical apparatus with translatable imaging device for real-time confirmation of interception of target tissue |
US10631893B2 (en) * | 2015-07-10 | 2020-04-28 | Warsaw Orthopedic, Inc. | Nerve and soft tissue removal device |
JP2019509847A (en) * | 2016-03-31 | 2019-04-11 | カーディアック ペースメイカーズ, インコーポレイテッド | Extraction device configured to extract medical devices implanted in the long term |
EP3515327B1 (en) | 2016-09-23 | 2024-02-14 | AtriCure, Inc. | Devices for left atrial appendage closure |
US11684248B2 (en) | 2017-09-25 | 2023-06-27 | Micronvision Corp. | Endoscopy/stereo colposcopy medical instrument |
US11832797B2 (en) | 2016-09-25 | 2023-12-05 | Micronvision Corp. | Endoscopic fluorescence imaging |
US10667838B2 (en) | 2017-01-09 | 2020-06-02 | United States Endoscopy Group, Inc. | Endoscopic snare device |
CN114246539A (en) * | 2017-01-23 | 2022-03-29 | 乌罗维乌公司 | Hand-held surgical endoscope |
KR20190112314A (en) | 2017-02-02 | 2019-10-04 | 프리시즌 토라식, 엘엘씨 | Minimally Invasive Method and Apparatus for Target Tissue Extraction |
US11771304B1 (en) | 2020-11-12 | 2023-10-03 | Micronvision Corp. | Minimally invasive endoscope |
USD874655S1 (en) | 2018-01-05 | 2020-02-04 | Medrobotics Corporation | Positioning arm for articulating robotic surgical system |
US11039850B2 (en) | 2018-02-28 | 2021-06-22 | Gi Supply | Endoscopic tool with suction for facilitating injection of a fluid into a submucosal layer of tissue |
WO2019191316A1 (en) | 2018-03-27 | 2019-10-03 | Sentreheart, Inc. | Devices and methods for left atrial appendage closure |
WO2019209921A1 (en) * | 2018-04-25 | 2019-10-31 | Boston Scientific Scimed, Inc. | Multifunctional electrosurgical instruments with dynamic electrode assemblies |
CN113924053A (en) * | 2019-07-16 | 2022-01-11 | 波士顿科学国际有限公司 | Devices and methods for treating hemorrhoids using suction |
EP4003138A4 (en) | 2019-07-25 | 2023-08-30 | Uroviu Corp. | Disposable endoscopy cannula with integrated grasper |
US11278268B2 (en) * | 2019-09-16 | 2022-03-22 | Inventio Lcc | Endoscopy tools and methods of use |
KR102301831B1 (en) * | 2020-04-28 | 2021-09-14 | 장영현 | Endoscope medical instrument for polyp remove |
KR102476766B1 (en) * | 2021-09-24 | 2022-12-12 | 장영현 | Medical Snare Equipment |
KR102593196B1 (en) * | 2021-09-24 | 2023-10-25 | 장영현 | Medical Snare Equipment |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0568296A1 (en) * | 1992-05-01 | 1993-11-03 | VANCE PRODUCTS INCORPORATED d/b/a COOK UROLOGICAL INCORPORATED | Surgical refractor |
Family Cites Families (54)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US798839A (en) * | 1904-05-21 | 1905-09-05 | Charles W Stowe | Illuminated snare. |
US1606497A (en) * | 1925-08-12 | 1926-11-09 | Alfred A R Berger | Surgical instrument |
US2737181A (en) * | 1955-01-17 | 1956-03-06 | Chester E Beard | Means for placing elastic bands |
US3155094A (en) * | 1961-11-27 | 1964-11-03 | Louis F Hamilton | Hemostatic instrument |
US3382273A (en) * | 1965-10-07 | 1968-05-07 | Galat Alexander | Stable, neutral, water-soluble derivatives of aspirin |
US3687138A (en) * | 1970-08-17 | 1972-08-29 | Robert K Jarvik | Repeating ligature gun |
DE2157911C2 (en) * | 1970-12-11 | 1982-02-04 | Marc Edmond Jean van Bruxelles Hoorn | Surgical device for ligating internal structures |
US3834392A (en) * | 1973-02-01 | 1974-09-10 | Kli Inc | Laparoscopy system |
DE2326988B2 (en) * | 1973-05-26 | 1977-02-24 | Drägerwerk AG, 2400 Lübeck | SURGICAL INSTRUMENT FOR STERILIZATION OF WOMEN THROUGH TUBE LIGATURE |
US3911923A (en) * | 1973-07-30 | 1975-10-14 | In Bae Yoon | Occlusion ring and method and device for its application |
US3967625A (en) * | 1973-07-30 | 1976-07-06 | In Bae Yoon | Device for sterilizing the human female or male by ligation |
US3870048A (en) * | 1973-07-30 | 1975-03-11 | In Bae Yoon | Device for sterilizing the human female or male by ligation |
US3989049A (en) * | 1973-07-30 | 1976-11-02 | In Bae Yoon | Method of applying an elastic ring to an anatomical tubular structure |
JPS5320957Y2 (en) * | 1973-11-14 | 1978-06-01 | ||
US4374523A (en) * | 1974-10-29 | 1983-02-22 | Yoon In B | Occlusion ring applicator |
US4103680A (en) * | 1975-08-15 | 1978-08-01 | In Bae Yoon | Multiple occlusion ring applicator and method |
US4085743A (en) * | 1976-03-02 | 1978-04-25 | In Bae Yoon | Multiple occlusion ring applicator and method |
JPS5641684Y2 (en) * | 1977-11-24 | 1981-09-30 | ||
US4222380A (en) * | 1977-12-02 | 1980-09-16 | Olympus Optical Co., Ltd. | Celiac injector |
US4226239A (en) * | 1978-01-31 | 1980-10-07 | Kli, Inc. | Surgical ligating instrument and method |
US4230116A (en) * | 1978-10-02 | 1980-10-28 | Kli, Inc. | Tubal ligation instrument with anesthesia means |
US4257419A (en) * | 1978-12-14 | 1981-03-24 | Mo Och Domsjo Aktiebolag | Suction-assisted hemorrhoid ligator |
US4257420A (en) * | 1979-05-22 | 1981-03-24 | Olympus Optical Co., Ltd. | Ring applicator with an endoscope |
US4267839A (en) * | 1979-09-12 | 1981-05-19 | Repromed, Inc. | Surgical instrument for use in reversible sterilization or permanent occlusion procedures |
JPS6031690Y2 (en) * | 1981-12-11 | 1985-09-21 | 株式会社 メドス研究所 | High frequency dissector for endoscope |
US4548201A (en) * | 1982-04-20 | 1985-10-22 | Inbae Yoon | Elastic ligating ring clip |
US4735194C1 (en) * | 1987-01-13 | 2001-05-08 | Dept Of Veterans Affairs The U | Flexile endoscopic ligating instrument |
DE8711635U1 (en) * | 1987-08-27 | 1988-01-21 | Gip Gastrointestinale Produkte Vertriebs Gmbh, 8221 Grabenstaett, De | |
SE460455B (en) * | 1987-09-30 | 1989-10-16 | Astra Meditec Ab | SURGICAL INSTRUMENT FOR BONDING INTERNAL WEAVES |
US4990152A (en) * | 1988-10-12 | 1991-02-05 | Inbae Yoon | Applicator device housing multiple elastic ligatures in series and for dilating and applying elastic ligatures onto anatomical tissue |
US5026379A (en) * | 1989-12-05 | 1991-06-25 | Inbae Yoon | Multi-functional instruments and stretchable ligating and occluding devices |
US5171314A (en) * | 1990-07-24 | 1992-12-15 | Andrew Surgical, Inc. | Surgical snare |
EP0474957A3 (en) * | 1990-09-11 | 1992-06-24 | Bozidar Ferek-Petric | Ultrasonic doppler synchronized cardiac electrotherapy device |
IT1247468B (en) * | 1991-03-06 | 1994-12-17 | Gianfranco Bidoia | TOOL FOR BINDING HEMORRHOIDS OR SIMILAR |
US5336227A (en) * | 1991-11-05 | 1994-08-09 | Wilk & Nakao Medical Technology Incorporated | Surgical cauterization snare with polyp capturing web net |
US5236434A (en) * | 1991-12-16 | 1993-08-17 | Callicrate Michael P | Method and apparatus for ligating a body part |
US5419309A (en) * | 1992-02-18 | 1995-05-30 | Biehl; Albert G. | Tip cleaning accessory for rigid endoscopic instrument |
US5356416A (en) * | 1992-10-09 | 1994-10-18 | Boston Scientific Corporation | Combined multiple ligating band dispenser and sclerotherapy needle instrument |
US5300078A (en) * | 1992-10-09 | 1994-04-05 | Laparomed Corporation | Device and method for applying large-diameter ligating loop |
US5269789A (en) * | 1992-10-09 | 1993-12-14 | Boston Scientific Corporation | Multiple ligating band dispenser for ligating instruments |
US5462559A (en) * | 1993-02-23 | 1995-10-31 | Ahmed; Munir | Endoscopic ligating instrument |
US5320630A (en) * | 1993-02-23 | 1994-06-14 | Munir Ahmed | Endoscopic ligating instrument for applying elastic bands |
US5417697A (en) * | 1993-07-07 | 1995-05-23 | Wilk; Peter J. | Polyp retrieval assembly with cauterization loop and suction web |
US5423830A (en) * | 1993-07-07 | 1995-06-13 | Schneebaum; Cary W. | Polyp retrieval method and associated instrument assembly |
US5376094A (en) * | 1993-08-19 | 1994-12-27 | Boston Scientific Corporation | Improved actuating handle with pulley system for providing mechanical advantage to a surgical working element |
JP2958219B2 (en) * | 1993-08-20 | 1999-10-06 | 住友ベークライト株式会社 | Endoscopic ligation kit |
US5425736A (en) * | 1993-11-09 | 1995-06-20 | Wadsworth; Legrand D. | Ligature tool to tension and fasten clips on surgical tubing |
US5501692A (en) * | 1994-01-28 | 1996-03-26 | Riza; Erol D. | Laparoscopic suture snare |
MY112272A (en) * | 1994-04-26 | 2001-05-31 | Kk Top | Endoscopic instrument for ligating varix |
US5542948A (en) * | 1994-05-24 | 1996-08-06 | Arrow Precision Products, Inc. | Surgical combination inject and snare apparatus |
US5846248A (en) * | 1995-04-13 | 1998-12-08 | Boston Scientific Corporation | Method and apparatus for severing and capturing polyps |
US5814052A (en) * | 1995-06-29 | 1998-09-29 | Nakao; Naomi L. | Surgical cauterization snare with ligating suture |
US5752961A (en) * | 1996-03-25 | 1998-05-19 | The University Of Kentucky Research Foundation | Angled snare assembly |
US5947978A (en) * | 1996-04-15 | 1999-09-07 | Medical Innovations Corp. | Surgical combination apparatus having first and second instruments operated from a common actuator |
-
1998
- 1998-02-18 US US09/025,499 patent/US5961526A/en not_active Expired - Lifetime
-
1999
- 1999-01-21 DE DE69935315T patent/DE69935315T2/en not_active Expired - Lifetime
- 1999-01-21 WO PCT/US1999/001253 patent/WO1999042041A1/en active IP Right Grant
- 1999-01-21 CA CA002320885A patent/CA2320885A1/en not_active Abandoned
- 1999-01-21 JP JP2000532062A patent/JP4246389B2/en not_active Expired - Fee Related
- 1999-01-21 EP EP99903249A patent/EP1056400B1/en not_active Expired - Lifetime
- 1999-07-19 US US09/357,105 patent/US6210416B1/en not_active Expired - Lifetime
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0568296A1 (en) * | 1992-05-01 | 1993-11-03 | VANCE PRODUCTS INCORPORATED d/b/a COOK UROLOGICAL INCORPORATED | Surgical refractor |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN101317783B (en) * | 2007-06-06 | 2012-05-23 | 伊西康内外科公司 | Double-pole probe with injection needle |
CN105615948A (en) * | 2016-03-09 | 2016-06-01 | 袁捷 | Gastrointestinal endoscope biopsy channel operating instrument |
Also Published As
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US5961526A (en) | 1999-10-05 |
US6210416B1 (en) | 2001-04-03 |
JP4246389B2 (en) | 2009-04-02 |
WO1999042041A1 (en) | 1999-08-26 |
DE69935315D1 (en) | 2007-04-12 |
DE69935315T2 (en) | 2007-11-22 |
JP2002503510A (en) | 2002-02-05 |
EP1056400A1 (en) | 2000-12-06 |
CA2320885A1 (en) | 1999-08-26 |
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